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HomeMy WebLinkAboutAMERICAN BICYCLE ASSOCIATION DBA USA BMX - INSURANCE CERTIFICATE (5)Client#: 1067930 AMERIBIC1 ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 13/01/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer any rights to the certificate holder in lieu of such endorsement(s). PRODUCER USI Insurance Services LLC 2375 E. Camelback Rd, Suite 250 NAME: Clorinda Thompson PHONE 602-234-4101 FAX A/C No Ext : A/C No): n DRESS: phx.certiflcates@usi.com Phoenix, AZ 85016 INSURER(S) AFFORDING COVERAGE NAIC # 602 279-5800 INSURER A: FhllaAslphla Indemnity In�unnee Co. 18058 INSURED American Bicycle Association dba: USA BMX P.O. Box 718 Chandler, AZ 85244 INSURER B : INSURER C INSURER D INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF MMIDD POLICY EXP MMIDDNYM LIMBS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR PHPK1783864 3/01/2018 03/01/2019 EACHOCCURRENCE$1,000000 PREM SES Ea occurrence $1 OO 000 MED EXP (Any one person) $ Excluded PERSONAL & ADV INJURY $1,000,000 _ GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY 7 JECOT 71 LOC OTHER: GENERAL AGGREGATE $5,000,000 PRODUCTS - COMP/OP AGG $1,000,000 $ A AUTOMOBILE LIABILITY X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS X HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY PHPK1783864 3/01/2018 03/01/201 COEaMBIaccident d.n,)S GLELIMIT $1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTYDAMAGE $ _— A X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE PHUB619392 1310112018 03101/2019 EACH OCCURRENCE s4,000,000 AGGREGATE s4,000,000 DIED I X RETENTION $1 O OOO $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A PER OTH- ISTAT E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Certificate holder and any other entities listed below are listed as additional insured under the General Liability on a primary 8r Non Contributory Basis including waiver of subrogation with respect to the American Bicycle Association/USA BMX sanctioned events/competitions/practices and other operations conducted by American Bicycle Association/USA BMX track operators on behalf of the American Bicycle Association/USA BMX. RE: Twin Silo BMX #1352 CERTIFICATE HULLER VAN1,r_LLAI IUN City of Fort Collins CIO John Stephen 215 N. Mason Fort Collins, CO 80524-0000 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) 1 of 1 #S22627552/M22615204 ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD JYCZP